Which specialty gives you the most freedom?

[Handsome88]

So I'd like to have a practice (full time) where I can control when I come to work and when I can go play golf or sleep in whenever I don't feel like working.

 

I know family medicine is one. Any other specialties/sub-specialties that allow you to be that lazy?

[shikimate]

Emerg Med, for real. As an example, I was talking to an EM doc just this week about observerships. She originally scheduled a shift on Sunday, but then her son have a football game on that day, so she simply switched the shift to Saturday night, voila now she can go to her son's football game on Sunday.

[Jochi1543]

Psych. It seems no one ever knows where half of them are or what their hours are.

[mavrik13]

So I'd like to have a practice (full time) where I can control when I come to work and when I can go play golf or sleep in whenever I don't feel like working.

 

I know family medicine is one. Any other specialties/sub-specialties that allow you to be that lazy?

 

Depends on your question. Is there a specialty that allows you to be lazy? No. You can't ditch out on a shift/clinic/OR day because you are feeling lazy. Medicine isn't like working at McDonalds. You have an obligation to your patients and your job.

 

Are there specialties that allow you to schedule yourself time for the activities you mentioned? Yes, many. Essentially, you can work as much as you want in many fields (i.e. take a part time job).

[moo]

Emerg Med, for real. As an example, I was talking to an EM doc just this week about observerships. She originally scheduled a shift on Sunday, but then her son have a football game on that day, so she simply switched the shift to Saturday night, voila now she can go to her son's football game on Sunday.

 

I know at least 4 emerg docs who have burned out. One was in a 5 year residency who switched in her 4th year to FM. Three were CCFP-EM's who switched back to family med due to family reasons and the pain of shift work. I know several other FRCPC emerg docs who end up doing mostly admin stuff with a couple shifts a month. It's not as glamorous as med students make it out to be.

 

And it's not as easy to switch shifts as you think it would be... you have to find someone willing to switch for you. And inevitably, you have to pull your share of the weight, and that means doing nights/evenings and weekends.

 

In FM, you have to pull your weight too. You better be responsible for your patients (meaning technically you are supposed to be on call or arrange call 24 hours a day for your patients. Leaving a phone message instructing them to call 911, unfortunately does not qualify). Patients can legitimately complain to the college if you haven't arranged call coverage. This applies to almost every speciality, even derm (although there are very few derm emergencies).

[Jochi1543]

 

In FM, you have to pull your weight too. You better be responsible for your patients (meaning technically you are supposed to be on call or arrange call 24 hours a day for your patients. Leaving a phone message instructing them to call 911, unfortunately does not qualify). Patients can legitimately complain to the college if you haven't arranged call coverage.

 

What if you are in a solo practice? And if you are on call, does it mean you get your on-call stipend from the provincial govt like locums do?

[moo]

What if you are in a solo practice? And if you are on call, does it mean you get your on-call stipend from the provincial govt like locums do?

 

If you are in solo practice, technically you are supposed to provide coverage 24/7. So you are in effect, on call all the time. Most, however, have arrangements with other solo/group practitioners for coverage.

 

Wording from the College of P&S in BC:

 

Do physicians have to provide their patients with access to care 24-hours a day, seven days a week?

The College recognizes that providing round-the-clock coverage for patient care can be problematic. However, physicians do have a social and an ethical obligation to look after their patients on a 24-hour basis and should make the necessary arrangements to ensure that alternate medical care is available even if their office or clinic is closed. Arrangements should be "bilateral" and if patients are referred to other clinics or physicians at hospitals, those physicians should have agreed to accept that responsibility. Arranging an on-call schedule with colleagues is the recommended best practice.

 

If a physician is unavailable for an extended period of time (i.e. illness or vacation), where possible, he/she should arrange for a colleague (or locum) to assume responsibility for his/her patients. When the physician is not "on call," leaving an answering machine message stating, "go to the nearest emergency room or walk-in clinic," is not considered to be an acceptable practice unless the physicians at such facilities have confirmed their willingness to assume that responsibility.

 

For me, I am on call all the time for my nursing home patients, unless I am away on vacation/conference, in which case I get someone else to cover.

 

I knew an ob/gyne in Edmonton who was a solo practitioner and she was always on call. Yes, that means, she would get called in the middle of the night for deliveries and she would come. If she was on vacation she got her locum or someone else to cover.

 

You usually get no stipend in BC. There is MOCAP here though (about 25/hour), but this is only for acute care hospitals and usually hospitalists (I think). Whenever I was on call for the clinic, I got no MOCAP and no compensation unless I was called in.

[bones]

Re: the on-call stipend not being provided for family physicians...

 

Some of you may have heard of so-called "concierge" medicine, where family physicians charge a yearly fee to their patients and in return offer quick appointments, 24/7 on call coverage, and other perks. One rationale I've heard for family physicians doing this (and, as they claim, the reason it doesn't contravene the Canada Health Act), is that this yearly fee is essentially an on-call stipend, which provincial medical plans don't cover.

[Handsome88]

Derm. For real.

 

Dent. For real.

 

Anything to do with cosmetics.

 

Teleradiology.

 

Not true. You are talking about a high salary to hours ratio and not control over your practice. Dermatologists still have no control over when they come to work, though they have little call.

[Endeavour]

Derm has tightened their market so well that they essentially call all the shots when it comes to their hospital contracts, so they have entire control over when and how they work.

 

I dont usually comment on brooksbane posts or even disagree with a few of them, but this time I MUST agree. DERM really does call the shots, for so many dam reasons.....

[NLengr]

I knew an ob/gyne in Edmonton who was a solo practitioner and she was always on call. Yes, that means, she would get called in the middle of the night for deliveries and she would come. If she was on vacation she got her locum or someone else to cover.

 

That sounds like a terrible life.

 

Being on call, every day, day in day out, seems like a sure fired way to burn out. Even if you don't get called in often, it puts major restrictions on your life.

[Renin]

Psychiatry.

 

Pretty flexible; but there is a lot of work to do when you're working. You can combine wards/outpatients/private practice. I hear there's the most flexibility in private practice because your pts are less acute, and well, it's your practice

[justletmein]

That sounds like a terrible life.

 

Being on call, every day, day in day out, seems like a sure fired way to burn out. Even if you don't get called in often, it puts major restrictions on your life.

 

there are VERY few obstetricians who do this anymore.

Most work in groups so they share the call, and patients have begun accepting that the person who delivers their baby may be anyone in the group.

 

Those who remain on call 24/7 --- well,, kudos to their dedication, but I would rather not be permanently tied to the hospital by a leash.

[moo]

there are VERY few obstetricians who do this anymore.

Most work in groups so they share the call, and patients have begun accepting that the person who delivers their baby may be anyone in the group.

 

Those who remain on call 24/7 --- well,, kudos to their dedication, but I would rather not be permanently tied to the hospital by a leash.

 

Yeah, nobody does that anymore, but she is dedicated.

[ghost dog]

If you are in solo practice, technically you are supposed to provide coverage 24/7. So you are in effect, on call all the time. Most, however, have arrangements with other solo/group practitioners for coverage.

 

Wording from the College of P&S in BC:

 

 

 

For me, I am on call all the time for my nursing home patients, unless I am away on vacation/conference, in which case I get someone else to cover.

 

I knew an ob/gyne in Edmonton who was a solo practitioner and she was always on call. Yes, that means, she would get called in the middle of the night for deliveries and she would come. If she was on vacation she got her locum or someone else to cover.

 

You usually get no stipend in BC. There is MOCAP here though (about 25/hour), but this is only for acute care hospitals and usually hospitalists (I think). Whenever I was on call for the clinic, I got no MOCAP and no compensation unless I was called in.

 

This is a completely inaccurate view of family medicine.

 

I am a family doc, and have been in solo practice for the past 8 years. My practice is primarily focused on chronic pain management, although I do have a small family practice as well. I can tell you that family physicians have tremendous flexibility in regards to their hours and areas of practice.

 

I am part of an extremely large family health group (a FHG) where I take home / phone call roughly once per year. As you can see, this is does not present a significant problem.

 

I work Monday to Friday 1 - 5 PM; pretty good hours by anyone's standards (although I do a fair amount of dictation and paperwork after hours - roughly 10 hours / week). The money is good.

 

I should also note that, with the fairly new initiative of the family health organization (FHOs), my friends ( with large family practices) have been telling me good things about FHOs. It's a pretty good time to be a family MD in Ontario.

 

In regards to solo office based practice:

 

1. You call all the shots (i.e. hiring / firing / vacation whenever you want).

2. No administrative / hospital based hassles.

[markov79]

no offense, but what kind of grown adult would make their username "ghost dog", lol.

[moo]

This is a completely inaccurate view of family medicine.

 

I am a family doc, and have been in solo practice for the past 8 years. My practice is primarily focused on chronic pain management, although I do have a small family practice as well. I can tell you that family physicians have tremendous flexibility in regards to their hours and areas of practice.

 

I am part of an extremely large family health group (a FHG) where I take home / phone call roughly once per year. As you can see, this is does not present a significant problem.

 

I work Monday to Friday 1 - 5 PM; pretty good hours by anyone's standards (although I do a fair amount of dictation and paperwork after hours - roughly 10 hours / week). The money is good.

 

I should also note that, with the fairly new initiative of the family health organization (FHOs), my friends ( with large family practices) have been telling me good things about FHOs. It's a pretty good time to be a family MD in Ontario.

 

In regards to solo office based practice:

 

1. You call all the shots (i.e. hiring / firing / vacation whenever you want).

2. No administrative / hospital based hassles.

 

Yes, you have arranged a big call group. I was involved in a call group once. I was on call about once per week. Not difficult but you had to make yourself available.

 

Most docs out here don't do call (even those in a "group" practice). They don't arrange for call either. Technically, the college frowns upon that.

 

Very few solo docs are on-call 24/7 nowadays, but you are supposed to provide coverage. Whether that is through yourself or through call groups, it's up to you. Most docs choose the latter nowadays.

 

As for me, I still have some nursing home patients for whom I provide coverage 24/7, unless I am on vacation, during which I arrange for coverage. Yes, this is even as a 5 year resident. Usually things are non-urgent, for which they fax me.

 

Family med can be rewarding, but very tiresome at times. You do get to run your own practice, but when you get staff that are unsatisfactory, firing/remediation/etc. can be a headache. As for vacation, my mom does the books for a large group practice (about 10 docs). Two of the docs are always taking vacation and the other docs are upset about having to always find locums for them. They are now proposing to charge those two docs 1000 bucks per week of vacation they take. These are all partners at the clinic, they share expenses, revenues, etc. Needless to say, the docs aren't happy. Thus, in a group practice, you still have *some responsibility. As a solo practitioner you don't have those kinds of politics but you are responsible for finding your own locum, which can be burdensome to say the least.

[ghost dog]

Yes, you have arranged a big call group. I was involved in a call group once. I was on call about once per week. Not difficult but you had to make yourself available.

 

Most docs out here don't do call (even those in a "group" practice). They don't arrange for call either. Technically, the college frowns upon that.

 

Very few solo docs are on-call 24/7 nowadays, but you are supposed to provide coverage. Whether that is through yourself or through call groups, it's up to you. Most docs choose the latter nowadays.

 

As for me, I still have some nursing home patients for whom I provide coverage 24/7, unless I am on vacation, during which I arrange for coverage. Yes, this is even as a 5 year resident. Usually things are non-urgent, for which they fax me.

 

Family med can be rewarding, but very tiresome at times. You do get to run your own practice, but when you get staff that are unsatisfactory, firing/remediation/etc. can be a headache. As for vacation, my mom does the books for a large group practice (about 10 docs). Two of the docs are always taking vacation and the other docs are upset about having to always find locums for them. They are now proposing to charge those two docs 1000 bucks per week of vacation they take. These are all partners at the clinic, they share expenses, revenues, etc. Needless to say, the docs aren't happy. Thus, in a group practice, you still have *some responsibility. As a solo practitioner you don't have those kinds of politics but you are responsible for finding your own locum, which can be burdensome to say the least.

 

Yup, there will always be admin headaches; but, thems the breaks. I like solo practice because I call all the shots and I don't have to hear other MDs sniping about - well whatever - you provide a good example above.

 

Another relevant issue in working in a group practice is that you have to work with what office managers give you. One of my friends works in a massive practice and has had an EMR system forced on him (although he didn't mind this - some of the older technodinosaurs did however ). I should note that his secretary is not the greatest; this clinic pays suboptimal wages, and you really do get what you pay for.

 

I have learned that a secretary is one of your most important assets in a clinic; she is absolutely vital to an office running smoothly. Pay these peeps well !!

 

I typically take 4-5 weeks of vacation a year , 1 week at a time and don't get a locum for those weeks. I perform a pretty specialized branch of medicine (interventional pain med / neural blockade + advanced knowledge), and thus it would be pretty much impossible to get someone for a week. My patients are fine with this set up; they know the drill.

[Dany]

I work Monday to Friday 1 - 5 PM; pretty good hours by anyone's standards (although I do a fair amount of dictation and paperwork after hours - roughly 10 hours / week). The money is good.

 

I know that in Montreal, for the docs only doing clinics (9 to 3, Mon to Fri) are paid 80k to 130k per year

I don't know whether that's called *good* money

[thebouque]

In Quebec if you do only ''clinic'' you have a 30% cut of your income because you are required to do at least 12 hours of AMP (particular medical activities) that include ER, OB, nursing homes, inpatients etc but NOT office based clinic. Family docs in Quebec have a more than decent income (150-200k in average and more if you work in remote areas).

[NLengr]

Quebec is the last place I would work out of any province, state or Western European country.

 

It really really has a terrible reputation among physicians.

[thebouque]

Quebec is the last place I would work out of any province, state or Western European country.

 

It really really has a terrible reputation among physicians.

 

I don't think it's that bad, and income wise they make a lot more than France and most western European countries. Judging by the number of western european IMGs who want a job in qc I don't think it's that unattractive. What do you really know about Quebec's system (non provocative genuine question)?

[thebouque]

I'll start:

 

1. The facilities are poor and very outdated. For instance, last time I was at the JGH in Montreal they still didn't have a PACS system in place. I mean, what is this, 1990?

 

2. They get paid less compared to basically every other province. Living in Quebec, unless you are in love with the nightlife and short skirts of Montreal, isn't worth the more than 50% paycut from what you'd earn in Ontario or BC or whatever.

 

3. You need to be fluent in French for most Quebec locations. Most people in Canada are not and have no desire to learn and practice in another language.

 

4. The provincial college requires mandatory recertification exams be written on a regular basis. This is the only province that does this. I've spoken to lots of physicians who have moved to Toronto, Vancouver, Calgary etc from Quebec, and they cited this as a huge PITA that, combined with the lower pay, isn't worth the hassle.

 

5. Outside of Montreal and QC, there isn't a lot going on in Quebec. To be fair there's probably more here than in SK or MB but those places are better, however marginally, in all other respects.

 

All your points are fair.

For the pacs thing indeed quebec was pretty late. I don't know when the jgh got their pacs but it's been around for over 6 years in hospitals in quebec city.

For point number 5 that's highly subjective, there are people who hate big centers and love rural areas and vice versa.

 

But I agree with the rest.

[ghost dog]

I know that in Montreal, for the docs only doing clinics (9 to 3, Mon to Fri) are paid 80k to 130k per year

I don't know whether that's called *good* money

 

 

I billed about three times that last year. I don't know what the fee schedules are like in that neck of the woods - but that is absolutely terrible.

 

In regards to IMGs working in Quebec, I'm pretty sure that this group are unable to access this province in regards to residency spots. I think the reasoning is that the vast majority don't speak French.

 

This is one of the (many reasons) why family residency spots in Quebec go unfilled - they are unwilling to take these foreign candidates. Or so I've been told.

[thebouque]

In regards to IMGs working in Quebec, I'm pretty sure that this group are unable to access this province in regards to residency spots. I think the reasoning is that the vast majority don't speak French.

 

This is one of the (many reasons) why family residency spots in Quebec go unfilled - they are unwilling to take these foreign candidates. Or so I've been told.

It's actually a mystery why IMGs are unable to access the province in regards to residency spots but it's not the language barrier because in Quebec we get TONS of IMGs form french speaking countries (countries from North African/arabic/sub saharic africa)